High administrative costs for filing and processing health insurance claims have typically been the bane of the health insurance industry for decades. Insurance claims include various information associated with a patient, such as the patient's insurance eligibility for a particular medical procedure. An unfortunate reality of today's healthcare industry typically is that billions of dollars are wasted in the processing of flawed insurance claims. Additionally, the processing of these insurance claims often wastes valuable time, typically resulting in an average revenue recognition cycle of over seventy days.
As a specific example, a medical professional (e.g., a receptionist) can verify the insurance eligibility of a patient by calling the particular insurance company. Alternatively, the receptionist can request eligibility information for the patient using a web portal electronically connected to the insurance company's web page. The receptionist types information about the patient into the web portal, transmits the information to the insurance company's web server, retrieves a response, and manually enters this information into a computer of the medical practice. Due to the large number of steps involved for this task and also due to the heavy workload frequently placed on the professionals performing these tasks, data entry errors often occur. These errors typically slow the process of successfully submitting an acceptable claim to the insurance company. For instance, the medical professional (e.g., receptionist) can forget to initiate an eligibility check, which can lead to significant billing and claim processing problems.
Other areas associated with the management of a medical practice, such as the claim acknowledgement area, often experience the same or similar problems. Particularly, once a medical practice submits an insurance claim to the insurance company, a medical professional typically has to sift through numerous claim acknowledgement reports to determine if the claim has reached its correct destination. This is a time-intensive, manual process that can be inundated with human error. These errors include, for example, errors in the comparison of the content of a report to the claim submission records stored in a medical practice management system. Another aspect of the process that often has similar problems includes the process of checking on the status of the claim as the claim traverses the insurance company system.
Given the extent of wasted time and money associated with the process, there exists a need to manage a medical practice in a more efficient manner and provide insurance claims with fewer or no errors.